Thermal skin burn in a late gestation period in experimental animals: state of the system “mother-fetus”

Objective. To study the effect of thermal skin burns in experimental animals (rats) on the state of the system “mother-fetus” in a late gestation period.Materials and methods. An experimental study was carried out on 18 female outbred white rats weighing 300–350 g (per 9 rats in the control and experimental groups), which were exposed to third-degree thermal burns with an area of 12 cм2 in a late gestation period. The oxygen transport function and the main blood biochemical markers were studied. The effect of thermal injury on the course of pregnancy was studied.Results. The thermal skin burn in the rats in the late gestation period leads to the development of hypoxia, a decrease in the affinity of hemoglobin for oxygen and metabolic acidosis in the mother’s body. Changes in the blood biochemical markers indicate the presence of endogenous intoxication. In the experimental animal group, a decrease in fetal weight was observed, an increase in the post-implantation fetal death rate was noted.Conclusion. Impaired oxygen homeostasis and endogenous intoxication in skin burns in rats in late gestation periods lead to fetal malnutrition and a qualitative increase in the post-implantation fetal death rate.

Does routine antenatal fetal testing in well-controlled diabetic pregnancies improve pregnancy outcomes? A systematic review and meta-analysis

Background: Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers, however there is no sufficient evidence to support this. Objective: The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes. Materials and Methods: The databases were searched to find English and Persian articles published from 1975-2018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review. Results: Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate was 5.6/1000, cesarean rate was 418/1000. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests the intrauterine fetal death rate isn’t different with general population. Conclusion: As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.

A CASE STUDY ON POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME WITH ECLAMPSIA

Posterior reversible neurological disorder syndrome may be a clinical syndrome characterized by varied conditions conferred by the patient need medicine, tomography diagnosing to advocate the treatment. Gestational toxemia of pregnancy toxemia begins throughout the pregnancy because the underlying medical condition of the mother later causes toxemia. These two clinical situations were approached by observatory medical aid depending on the mother’s health and nutrition. Here, this case study is of a 37-year-old who conferred in post-pregnancy cesarean with seizures, high pressure, disturbed mental state, and high blood glucose levels. Pregnancy-related clinical syndromes are hugely dependent on the mother’s well-being. Syndromes during pregnancy not solely influence the mother’s health additionally cause severe hurt to the fetus because leading to rise in premature births, fetal death rate, and inflicting psychological distress to the mother’s mental health.

FETOMATERNAL OUTCOMES IN PREEKLAMPSIA PATIENTS WITH PROTEINURIA AND WITHOUT PROTEINURIA

BACKGROUND AND OBJECTIVES : The high maternal mortality rate is still found mainly in Southeast Asia including Indonesia. Maternal deaths that occur are caused by various things. High blood pressure during pregnancy (preeclampsia and eclampsia) is one of the major causes of maternal death in the world besides heavy bleeding (usually postpartum) and infection. The relationship between proteinuria and poor fetal outcomes has been investigated by experts,increasing protein excretion in women with preeclampsia (PE) is generally associated with poor maternal and fetal (fetomaternal) outcomes, proteinuria levels in women with PE are poor predictors of outcomes fetomaternal. But another opinion says that proteinuria is not an absolute criterion that must be found to diagnose PE, where multiorgan dysfunction in PE patients with or without proteinuria does not have a significant difference. From these results the researchers wanted to know the fetomaternal outcomes of PE patients with proteinuria (+ 1, + 2, + 3, + 4) and preeclampsia without proteinuria. METHODS :This research is a descriptive study with a retrospective design,carried out using secondary data analysis of patients diagnosed with PE with or without proteinuria and have been terminated.This research was conducted at the General Hospital. H. Adam Malik Medan. The time of the study is from October 2017 to February 2018. The study population is PE patients treated and terminated from February 2013 to May 2017. PE patients in this study will henceforth be assessed based on protein levels in the urine (proteinuria). The sample size in this study uses the Lemeshow formula which aims to find a large proportion in a population. RESULTS: A total of 62 PE women with proteinuria and 21 PE women without proteinuria. Of all the samples, maternal and fetal outcomes were assessed.Based on Proteinuria,research subjects who were diagnosed with PE with proteinuria were 62 people.The highest number was 36.1% in PE with proteinuria + 3,followed by 18.1% in PE with proteinuria +1, then as much as 15.7% in PE with proteinuria +4,and with the smallest amount of 4.8% in PE with proteinuria +2.Research subjects diagnosed with PE without proteinuria totaled 21 people,as many as 25.3% of the total sample. CONCLUSION : Most research subjects ranged age 21-30 years with gestational age,≥ 37 weeks, multipara. Subjects were diagnosed with PE with proteinuria more than PE without proteinuria.The most maternal outcome is ICU treatment followed by HELLP syndrome, eclampsia and pulmonary edema then maternal death. The highest fetal death rate for babies with birth weight is LBW,with more normal APGAR scores

Emergency cerclage: gestational and neonatal outcomes

SUMMARY BACKGROUND: The gestational and neonatal outcomes of women with early cervical dilatation undergoing emergency cerclage were evaluated and compared with women treated with expectant management and bed rest. METHODS: Retrospective analysis of pregnant women admitted between 2001 and 2017 with a diagnosis of early cervical dilatation and/or bulging membranes. Patients with a singleton pregnancy of a fetus without malformations, between 16 and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included; patients who delivered or miscarried within 2 days after admission were excluded. RESULTS: The study enrolled 30 patients: 19 in the cerclage group and 11 in the rest group. There was a significant difference, with the cerclage group showing better results concerning gestational age at delivery (28.7 vs. 23.3 weeks; p=0.031) and latency between hospital admission and delivery (48.6 vs. 16 days; p=0.016). The fetal death rate was lower in the cerclage group (5.3% vs. 54.5%, p=0.004). Considering gestational age at delivery of live newborns, no difference was observed between the cerclage and rest groups (29.13 vs. 27.4 weeks; p=0.857). CONCLUSIONS: Emergency cerclage was associated with longer latency, a significant impact on gestational age at delivery and reduction in the fetal death rate.

Estimating the Attack Rate of Pregnancy-Associated Listeriosis during a Large Outbreak

Background. In 2011, a multistate outbreak of listeriosis linked to contaminated cantaloupes raised concerns that many pregnant women might have been exposed toListeria monocytogenes. Listeriosis during pregnancy can cause fetal death, premature delivery, and neonatal sepsis and meningitis. Little information is available to guide healthcare providers who care for asymptomatic pregnant women with suspectedL. monocytogenesexposure.Methods. We tracked pregnancy-associated listeriosis cases using reportable diseases surveillance and enhanced surveillance for fetal death using vital records and inpatient fetal deaths data in Colorado. We surveyed 1,060 pregnant women about symptoms and exposures. We developed three methods to estimate how many pregnant women in Colorado ate the implicated cantaloupes, and we calculated attack rates.Results. One laboratory-confirmed case of listeriosis was associated with pregnancy. The fetal death rate did not increase significantly compared to preoutbreak periods. Approximately 6,500–12,000 pregnant women in Colorado might have eaten the contaminated cantaloupes, an attack rate of ~1 per 10,000 exposed pregnant women.Conclusions. Despite many exposures, the risk of pregnancy-associated listeriosis was low. Our methods for estimating attack rates may help during future outbreaks and product recalls. Our findings offer relevant considerations for management of asymptomatic pregnant women with possibleL. monocytogenesexposure.

Abnormal Umbilical Cord Coiling is Associated with Adverse Perinatal Outcomes

The normal umbilical cord coil index is one coil/5 cm, i.e., 0.2 ±0.1 coils completed per cm. We report the frequency and clinical correlations of abnormally coiled cords among 1329 cases referred to our placental pathology services. Twenty-one percent of cords were over-coiled and 13% were undercoiled. Abnormal cord coiling was seen at all gestational ages. Principal clinical correlations found in overcoiled cords were fetal demise (37%), fetal intolerance to labor (14%), intrauterine growth retardation (10%), and chorioamnionitis (10%). For undercoiled cords, the frequencies of these adverse outcomes were 29%, 21%, 15%, and 29%, respectively. Abnormal cord coiling was associated with thrombosis of chorionic plate vessels, umbilical venous thrombosis, and cord stenosis. Thus, abnormal cord coiling is a chronic state, established in early gestation, that may have chronic (growth retardation) and acute (fetal intolerance to labor and fetal demise) effects on fetal well-being. The cause of abnormal cord coiling is not known. Its effects on neurological status of survivors are also unknown. Antenatal detection of abnormal cord coil index by ultrasound could lead to elective delivery of fetuses at risk, thereby reducing the fetal death rate by about one-half. We recommend that the cord coil index become part of the routine placental pathology examination.

Reducing Fetal Deaths in Multiple Births: Optimal Birthweights and Gestational Ages for Infants of Twin and Triplet Births

The objective of this study was to determine the birthweight and gestational age associated with the lowest fetal mortality for twins and triplets. The study design was a population-based analysis of all live births and fetal deaths in the US between 1983-88. Fetal mortality was compared by categories of birthweight and gestational age, for twins and triplets versus singletons, and within each plurality by the lowest rate compared to all other rates as relative risks ± 95% Cls. The overall versus lowest fetal death rate per 1,000 conceptions for singletons was 4.3 versus 0.9 at 3700-4000 g and 40-41 weeks; for twins, 15.5 versus 3.3 at 2500-2800 g and 36-37 weeks; and for triplets, 21.0 versus 5.2 at 1900-2200 g at 34-35 weeks. Beyond these plurality-specific lowest ranges, the risk of fetal death increased, more for twins than singletons, and most for triplets. To conclude, fetal death rates can be reduced by 75-80% with attainment of birthweight and gestational age within a plurality-specific ideal range.

Ultrasound guided blood sampling from fetal sheep

The feasibility of obtaining fetal blood samples by needle aspiration under ultrasound guidance was assessed in 32 fetal sheep from 101-1 36 days' gestation. Seventy-six attempts at blood sampling were made, of which all but two were successful. The overall fetal death rate resulting from this procedure was 9.2%. However, with increasing operator experience and with advancing gestational age, 95.5% of fetuses survived the procedure. Repeated sampling from individual fetuses had minimal effects on arterial blood gas values. Ultrasound guided blood sampling now provides an alternative to chronic catheterization as a basis for some types of research with fetal sheep.